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Enhancing Global Cooperation — Lancet Commission on COVID-19 (



In order to prevent future pandemics, it is essential to understand the origins and emergence of COVID19 and to undertake a One Health approach for preserving and enhancing ecosystem and human health. The current pandemic is the latest in a series of recent emerging zoonotic diseases. Several have involved viruses with origins in bat populations, including Severe Acute Respiratory Syndrome (SARSCoV), Middle-East Respiratory Syndrome (MERS-CoV), Ebola, and now COVID-19 (SARS-CoV-2). Three objectives must be achieved to understand the origins of the pandemic. The first is to identify the most likely origin of SARS-CoV-2 and the pathway by which it emerged in people. We seek clarity on the animal species, location, and time at which the virus first infected people, and on whether an intermediate host was involved. Additionally, a number of studies reported the presence of SARS-CoV-2 earlier than December in China and prior to January in other countries, although it is unclear at this stage how rigorous these studies are. The second objective is to assess the early spread of COVID-19 and to understand the reasons that control measures were unable to contain the initial outbreak. The first confirmed case of COVID-19 in people appears to have been in early December in Wuhan. The Wuhan and Hubei authorities were actively working to suppress a growing outbreak by mid-December, and the Federal CDC (China CDC) was involved at the end of December. Despite rapid identification of a causative agent and travel restrictions in the lead up to the Chinese New Year, the virus spread internationally. The reasons that this virus was able to spread so effectively are uncertain, and the trajectory of this outbreak differs significantly from SARS-CoV. The third objective is to identify One Health solutions to future pandemic threats. All prior pandemics and LANCET COVID-19 COMMISSION ENHANCING GLOBAL COOPERATION 21 most known emerging diseases have originated in non-human animals, usually wildlife, and have emerged due to environmental and socioeconomic changes, such as land use change, agricultural expansion, and the wildlife trade. These drivers bring people, livestock, and wildlife into closer contact across large swathes of the planet and are the factors behind the emergence of HIV/AIDS, Ebola, SARS, Nipah virus, and likely COVID19. The COVID-19 pandemic has also involved farmed animals, with outbreaks of COVID-19 in mink farms in Europe and the US. This virally mediated connection among the environment, animals, and people is a One Health problem that underpins pandemic risk, and we must identify One Health approaches to controlling future pandemics.